Does Patient Blood Glucose Monitoring Improve Diabetes Control?

A Systematic Review of the Literature

From Rutgers University, Department of Psychology, Institute for Health & Behavior, New
Brunswick, New Jersey (Ms McAndrew, Dr Leventhal); Robert Wood Johnson Medical School, Division of
Endocrinology, Diabetes, Metabolism, New Brunswick, New Jersey (Dr Schneider); and Department of
Medicine, Medical College of Wisconsin, Milwaukee (Dr Burns). This article was funded through funds
from the National Institute of Health, grant R24 AG023958, Center for the Study of Health Beliefs
and Behaviors.

Objective

The purpose of this systematic review was 2-fold: first, to perform a comprehensive review of
relevant studies on the impact of self-monitoring of blood glucose (SMBG) on HbA1c levels for
patients with type 2 diabetes mellitus and, second, to explore mediators and moderators within a
self-regulation framework.

Study Selection

Cross-sectional, longitudinal, and randomized control trials from 1990 to 2006, which included
patients with type 2 diabetes not on insulin, were reviewed. In total, 6769 studies were screened
for inclusion, 89 were retrieved for detailed analysis, and 29 met criteria for inclusion in the
review.

Data Extraction

Data on the impact of SMBG on HbA1c, potential mediators and moderators, study design and
participants, and limitations of each study were retrieved.

Data Synthesis

Twenty-nine studies were included in this review: 9 cross-sectional studies, 9 longitudinal
studies, and 11 randomized controlled trials. Evidence from the cross-sectional and longitudinal
studies was inconclusive. Evidence from randomized controlled trials suggests that SMBG may lead to
improvements in glucose control. Very few studies examined potential mediators or moderators of
SMBG on HbA1c levels.

Conclusions

SMBG may be effective in controlling blood glucose for patients with type 2 diabetes. There is a
need for studies that implement all the components of the process for self-regulation of SMBG to
assess whether patient use of SMBG will improve HbA1c levels.